Splenic artery embolization is an endovascular technique for treatment of splenic and splenic artery pathology as an alternative to splenic artery ligation or splenectomy. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology . Here, we present a case of ruptured splenic artery aneurysm in a 59-year-old gentleman presenting with epigastric pain and hypovolemic shock. The majority of patients show no signs or symptoms [ 1 ]. At present, there are two main ways to treat splenic aneurysms: one is interventional therapy, and the other is surgical treatment. Open splenectomy and aneurysmectomy are safe treatment options for aneurysm of the distal third of the splenic artery with impending rupture, as it is sometimes not possible to preserve the spleen. Rupture of splenic artery aneurysm is rare, occurring in between 3 and 10% of cases [7, 8], but reported mortality from ruptured splenic artery aneurysm is between 25 and 65% [9,10]. . There is some debate in the literature regarding the exact threshold for intervention. Splenic artery aneurysms (SAA) are the third most com-mon type of arterial aneurysm, with diameters rang-ing from 0.6 to 30 cm. 3-D reconstruction from CTA (obtained before pregnancy) demonstrating the 13 mm 9 mm aneurysm of the splenic artery branch to the upper pole of the spleen, distal to the branch supplying the . 1,2 Although SAAs are considered rare, they remain . Atherosclerotic disease (cholesterol buildup in arteries) may also lead to the formation of some aneurysms. Introduction. A splenomesenteric trunk, which involves the splenic artery arising from the superior mesenteric artery (SMA), is rare and occ. Aneurysms occur from the weakening and thinning of the artery wall. At present, they are classified according to the anatomy of the injury. Splenic artery aneurysms are most often asymptomatic. The study methods described were performed in accordance with CARE guidelines and other relevant regulations. OBJECTIVE: Endovascular treatment (ET) is being increasingly used for splenic artery aneurysms (SAAs), but systematic treatment strategies have not been defined. Splenic artery aneurysms (SAAs) are the third most frequent intra-abdominal aneurysm and the most common (46-60%) of all visceral artery aneurysms. Radiographic features S, spleen. Splenic artery aneurysms (SAAs) are the third most common abdominal aneurysm preceded only by aortic and iliac artery aneurysms, and comprise the majority of visceral artery aneurysms.1 Despite this fact, SAAs are relatively rare and remain an insidious entity. A splenic artery aneurysm is a bulging, weakened section of the artery that supplies blood to your spleen and parts of your pancreas and stomach. The main risk of these aneurysms is rupture. When clinically appropriate, these procedures may provide an alternative to open surgery. The splenic artery is the third most common site of intraabdominal aneurysms after aneurysms of the abdominal aorta and the iliac arteries [].The true prevalence is unknown, with estimates varying widely, from 0.2% to as high as 10.4% [2, 3].Although they were once thought to be rare, with wider use of cross-sectional imaging, splenic artery aneurysms are being diagnosed with increasing . Treatment options for splenic artery aneurysms (SAAs) include open surgical repair, percutaneous intervention with either embolization Evaluation of splenomegaly and other splenic disorders in adults site for abdominal artery aneurysm, after the aorta and iliac arteries. Peripheral calcification is common, and mural thrombus may be present 12 . The prevalence of splenic artery aneurysms (SAAs) ranges from 0.1% to 2%. The diagnosis was made by emergency ultrasound and CT scan, and he was managed by laparotomy and excision of the splenic artery aneurysm. Symptomatic patients exhibit vague left upper quadrant or epigastric discomfort and occasional radiation of pain to the left shoulder or subscapular area. Endovascular treatment is the standard of care for splenic artery aneurysms. Many people have no symptoms, but a common symptom is pain in the upper left side of your belly. In many cases of ruptured aneurysm, emergent intervention is recommended. Most are small (less than2 cm), saccular aneurysms, and more than 80%are located in the mid or distal splenic artery.These aneurysms are 4 times more common in womenthan in men. In the absence of guidelines, the main recommended indications for intervention of splenic artery aneurysm are rupture, aneurysm size larger than 2 or 2.5 cm, growth of the aneurysm by 3 to 5 mm or more during surveillance regardless of initial size, symptoms, women of childbearing age, portal hypertension, and planned liver transplant. S, spleen; I . Fusiform aneurysms involve the entire circumference, and saccular aneurysms involve only a portion of the vessel wall. It is seldom diagnosed when encountered clinically, because it is not considered in the differential diagnosis. Selective laparoscopic aneurysm resection is a safe and effective approach, with good short- and long-term results, allowing permanent treatment of SAA while maintaining splenic function. The splenic artery aneurysm is defined as when a focal dilatation is observed, and its diameter is >50% of the normal vessel diameter [1]. Splenic artery aneurysms (SAA) are defined as more than 1-cm pathologic dilation of the splenic artery. Bessoud B, Duchosal MA, Siegrist CA, et al.. Proximal splenic artery embolization for blunt splenic injury: clinical, immunologic, and ultrasound-Doppler follow-up. B, Upper portion of the spleen is nearly devoid of any contrast, indicating localized infarction due to dislodgement of a metallic coil from the aneurysm at the upper part of splenic hilum (arrowhead). The coils are introduced through a catheter and disturb the blood flow in the artery, causing thrombosis. Splenic artery aneurysm is a rare but a potentially fatal condition. These SVS evidence-based practice guidelines offer recommendations to inform the diagnosis, treatment options, screening and follow-up of visceral aneurysms. Aneurysms of the renal artery and splenic artery are uncommon but clinically important, as they pose a risk of rupture with a high fatality rate. Peripheral aneurysm types A mesenteric (splenic, hepatic, or celiac) aneurysm occurs in an artery located in the abdomen, but not in your aorta. J Trauma. A peripheral aneurysm is an enlargement or weakened area in an artery other than your aorta, often in your legs or neck. The laparoscopic procedure is safe and feasible in the selected patients. True splenic artery aneurysms (SAAs) involve all layers of the wall, each of which is intact and thinning. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. Congenital Antitrypsin Deficiency Cystic Medial Necrosis Ehlers-Danlos Syndrome Marfan Syndrome Neurofibromatosis The exclusion of the aneurysm was obtained and the patency of the splenic artery was preserved without technical complications. When a part of the arterial wall swells and stretches to . Optimal surveillance and treatment of renal and splenic artery aneurysms Cleve Clin J Med. , . The size of splenic artery aneurysms can range from 2 to 9 cm, but usually, it is smaller than 3 cm. In endovascular procedure, the thin platinum or steel coils are placed in main splenic artery aneurysm site. 2007; 62: 1481-1486. Fusiform aneurysm, large aneurysms, and aneurysms associated with proximal renal artery stenosis or fibromuscular dysplasia (FMD) are usually repaired in this manner. After segmental excision of the aneurysm and renal artery, the preferred arterial reconstruction is with an autogenous saphenous vein aortorenal bypass graft. CONSERVE 2021 Guidelines for Reporting Trials Modified for the COVID-19 Pandemic FDA . Risk factors for aneurysm formation and rupture include pregnancy and portal hypertension. 2 In this case further aggressive investigations were not done considering her co-morbid conditions. However, in cases of SAA rupture, minimally invasive interventions are unsuitable, and open surgery remains the gold standard method. A 54-year-old woman complained of upper left abdominal pain for 6 months. A pseudoaneurysm ("false aneurysm") is a localized arterial disruption of the intimal and medial layers; it is lined by adventitia or perivascular tissue and caused by blunt or penetrating trauma. Over time, calcium deposits in the arterial wall weakens the lining and causes a ballooning effect. Splenic artery pseudoaneurysm (PSA) is a contained vascular wall lesion associated with a high mortality rate, generally related to pancreatitis, trauma, malignancy, iatrogenic injury, and segmental arterial mediolysis. Aneurysms of the splenic artery are the most common visceral aneurysm. Authors Tom Kai . Endovascular interventions are increasingly used in the treatment of a splenic artery aneurysm (SAA), which is a rare and life-threatening clinical disorder. A visceral artery aneurysm is a ballooning of a section of the splenic, renal, hepatic or mesenteric arteries. A celiac artery aneurysm is a dilatation of the celiac artery. 2005; 189: 335-339. Aneurysm of the splenic artery is an infrequent lesion. These arteries supply blood to the visceral organs - the spleen, kidney, liver and intestines, respectively. Ekeh AP, McCarthy MC, Woods RJ, Haley E. Complications arising from splenic embolization after blunt splenic trauma. Computed tomography angiography allows us to visualize the vascular anatomy, differentiate a PSA from an aneurysm, and provide adequate information for endovascular/surgical . High blood pressure is thought to play a role in abdominal aortic aneurysms. The management flowchart will be applied to SAA cases in Aneurin Bevan University Health Board. e majority of patients show no signs or symptoms [1]. The 2022 Society for Vascular Surgery guidelines suggest to intervene if the size is greater than 2 cm and there is demonstrable growth. The splenic artery is the most common visceral artery affected by aneurysms and pseudoaneurysms, and only less frequent than aortic and iliac . Lessons: Patients with distal SAA can be treated by laparoscopic aneurysmectomy with end-to-end anastomosis to preserve the spleen. We report a case who was presented with splenic artery aneurysm. The key to surgical treatment of splenic artery aneurysms is to totally exclude the SAAs. The objective of this study was to review our experience with open repair, endovascular therapy, and observation of SAAs over a 14-year interval. The entity, because of its rarity, is seldom. It often results in successfully treating the underlying pathology, while maintaining at least partial splenic function. Abstract Objectives: The management of patients with splenic artery aneurysms (SAAs) is variable since the natural history of these aneurysms is poorly delineated. The exact cause of a splenic artery aneurysm is uncertain, while Summarize the treatment options for splenic artery aneurysm. MD Splenic artery aneurysms are the most commonvisceral artery aneurysms; they account for up to60% of such lesions. 11, 12 This appears to be a promising minimally invasive approach in managing this rare entity. Splenic artery aneurysms (SAA) are the third most common type of arterial aneurysm, with diameters ranging from 0.6 to 30 cm. Catheter technique is used to treat splenic artery aneurysm. Citation, DOI & article data. Treatment of splenic artery aneurysm A standard threshold of operative intervention for a splenic artery aneurysm (SAA) was 2 cm in diameter. Am J Surg. This is usually caused by a weakened area in the arterial lining. The normal diameter of the splenic artery varies and ranges from 0.43 cm to 0.49 cm. The study . These coils will cause disturbance in blood flow via subsequent thrombosis. 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